Alternative technique for tip support in secondary rhinoplasty.

BACKGROUND Re-establishing nasal tip projection is one of the main objectives in secondary rhinoplasty. The columellar strut is used as a basic element for support and the septal cartilage graft as the first choice for reconstruction. Nevertheless, the septal cartilage is often missing in this category of patient because of previous surgery, obliging the surgeon to seek a safe, effective, and versatile alternative. OBJECTIVE We describe a simple procedure to increase the strength of an autologous ear graft cartilage to be used as a columellar strut in patients having secondary rhinoplasty. METHODS We removed a 3.5 x 1.5-cm auricular concha graft through a postauricular approach, leaving the perichondrium on the posterior surface and trimming it on the helical crus. Later, we made a cylinder-shaped structure to be used as a columellar strut graft in patients in whom the septum was absent. We used the open rhinoplasty technique, applying the basic principles of secondary rhinoplasty, in all of the patients. RESULTS Between February 2002 and June 2006, we used this technique in 13 patients ranging in age from 19 to 52 years who required revision rhinoplasty. The clinical follow-up period ranged from 4 to 48 months. Five of the patients experienced minor complications; nevertheless, all were satisfied with the postoperative results. CONCLUSION The auricular cartilage struts constructed using this method were strong enough to enhance tip support and projection, with satisfactory results assessed by both the patients and our team.